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What Hillary's election will mean for drug prices, health care

If past is prologue and American voters make a hold-your-nose, less-worse choice that puts Hillary Clinton in the White House, then it would be instructive to review a few highlights from her public career to assess what her presidency might mean for U.S. drug prices.

  1. In 1978, shortly before Bill Clinton was elected governor of Arkansas, Hillary earned a windfall $100,000 during one year of trading commodities. As a novice commodity trader, she received advice from James B. Blair about which trades to make. Blair was a lawyer who worked as the lead outside attorney for Tyson Foods, the largest poultry company in the U.S. According to the New York Times, when Bill was governor, "Tyson benefited from a variety of state actions, including $9 million in government loans, the placement of company executives on important state boards and favorable decisions on environmental issues."

  1. The same year, the Clintons formed a real estate partnership with a former gubernatorial aide and his wife, James and Susan McDougal, to buy 220 acres of land in Arkansas and create the Whitewater Development Corp. for selling vacation home sites. As an attorney at the Rose Law Firm in Little Rock, Hillary represented McDougal's Madison Guaranty Savings & Loan before the Arkansas state Securities Commissioner. Four years later Madison Guaranty went into receivership after making bad loans. McDougal was subsequently convicted of fraud and imprisoned. The Washington Post's 1996 assessment of the Whitewater scandal stated that Hillary Clinton displayed a pattern of routinely "avoiding full disclosure, occasionally forgetting places and events that might embarrass her, and revising her story as documents emerge and the knowledge of her questioners deepens."

  1. As U.S. Senator from New York, Hillary never supported the bill to end the carried-interest loophole that would have stopped hedge fund managers from paying lower taxes on their incomes in the form of capital gains.

The Atlantic described her period in the Senate as marked by "systematic caution. But it remains a question of whether it was caution or duplicity that led Senator Clinton to vote in favor of a bankruptcy reform bill that "made it harder for people to wipe out unsecured debts" such as credit cards. The legislation also made it more difficult for "a woman owed child support payments to collect it if the child's father declared bankruptcy." The New York Times this year reported that the "legislation was avidly sought by the banking and credit card industries."  Sen. Elizabeth Warren, then a Harvard law professor, "cited Mrs. Clinton's campaign fund-raising from the banking industry as a factor in her vote."

  1. As Secretary of State from 2009 through 2013, Hillary consistently skirted a conflict of interest in regard to the Clinton Foundation. Several benefactor companies of the Clinton Foundation such as UBS and Boeing conducted business with the State Department and Hillary was a strong advocate on behalf of both. The Foundation's donor list showed that it received substantial contributions from foreign governments such as Saudi Arabia and Qatar. At the same time, several of Hillary Clinton's State Department aides such as Huma Abedin were also receiving salaries from the Clinton Foundation where they conducted work for corporations and foreign governments.

This brief review reveals Hillary Clinton's tendencies to deliberately block transparency, rationalize her conduct, change her story when new evidence emerges, cozy up to wealthy benefactors for financial and political gain, and exercise headstrong control that is oblivious to risk and ethical infractions.

What does this suggest about how she is apt to address the issue of increasingly unaffordable medication costs?

First, it appears questionable whether she will even deal with substantive aspects of the issue.  Barack Obama was elected in 2008 principally because the financial system tanked during the waning days of George W. Bush's second term and the country was losing hundreds of thousands of jobs. Yet Obama's response to the worst recession since the 1930s was pitifully weak and evasive as he spent only a fraction of what the Keynesian economists said was necessary to stimulate demand.  Instead he wasted most of his political capital and lost majorities in both houses of Congress by pressing a watery-soup health care reform when that issue lacked the urgency of righting the economy.

The essence of strong political leadership consists of addressing the most important issues and making tough decisions that determine who wins, who loses and who pays for it. Obama and Clinton are both neo-liberals who run away from such decisions. That makes it likely Hillary will avoid the tough knife fight of prescription drugs and health care, preferring instead an easier layup involving something such as child care, violence against women or parental leave.

The probability of Clinton not even getting around to prescription drug prices is also increased by the fact she is a foreign policy neo-con and a military hawk who may well embroil the U.S. in a protracted war. Democrats Woodrow Wilson, Franklin Roosevelt and Lyndon Johnson all learned, to their sorrow, that progressive advances at home cool down and cease when foreign wars heat up.

Second, any approach Hillary does take to reigning in drug prices will first need the approval of her Big Pharma donors. Clinton's entire political approach of "triangulation" involves courting, supplicating and benefitting major corporate interests. Pharma made more campaign contributions to Hillary Clinton than to any other candidate as the result of a cold, hard, bought-and-paid-for "understanding." As a result, any relief she does secure on drug prices will be small beer.

Third, any substantial relief on drug prices for American consumers and taxpayers must involve creating a single-payer health care system that will also confront the amoral greed of provider networks and insurers. That necessarily involves a big picture change of the sort that a conservative technocrat such as Hillary Clinton tries to avoid. She prefers instead 1,000-page legislation, consisting of long sentences full of dependent clauses, intransitive verbs and double conditionals, with the entire mess constituting an unwieldy, Rube Goldberg apparatus.

While drug affordability under any of the Republican candidates remains entirely unimaginable, the chances are that the U.S. can expect only paltry improvements on that issue from a Hillary Clinton presidency.

Only one path makes drug cost relief with President Hillary Clinton even conceivable, although it would still remain a longshot.

The overriding principle and the tactical goal of any politician consists of winning re-election. Hillary Clinton is no different. Before she endorses any piece of corporate fleecing, it may bring some pause to her hand if she reflexively anticipates that the action will jeopardize her re-election because a vocal segment of people who voted for her in 2016 will see it as a corporate sellout.

The time to establish that conditioned reflex in Hillary Clinton starts after the Democratic convention in Philadelphia, if the party fails to nominate Bernie Sanders. That's when supporters of Sanders, as well as voters who are repulsed by all the candidates, will start to feel they must hold their noses and vote for Hillary, if only because the Republican candidate is entirely reprehensible. Progressives who reluctantly decide to vote for Hillary must still make it known that they disdain her neo-liberal opportunism and her corporate toadying.

To drive across the point, hold-your-nose Hillary voters should readily acknowledge that she is a liar and a corporate sycophant, even as they loudly proclaim that they are voting for her only because the Republican candidate in 2016 is even more heinous.

Can a vote plus vituperation imbue Hillary Clinton with some principle and a genuinely progressive policy on health care? The chances are slim, but the gesture will at least encourage some people in both parties who do possess some integrity to make a run in 2020.

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